Webinar Registration Form

PORTLAND INSTITUTE FOR LOSS AND TRANSITION

 

Holding onto Grief

Working with Pro-Symptom Positions in Bereavement

 

August 28, 2020 (Friday), 9am-11am, PDT or

August 31, 2020 (Monday), 9am-11am, SGT

IMPORTANT! Site members please log in to link your data from the certification program.

For site members, please log in.

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Personal Particulars: (for site members, please login to auto fill the basic information)

*First Name

Middle Initial

*Family Name

*Phone

*Email Address

*Address

*City

State / Province (if applicable)

*Country

Professional Background

*Name of Organization

*Address of Organization

*Type of Organization

Private Practice

Hospice / Palliative Care

Hospital

Community Services

Educational Institution

Funeral Home

Others:

*Discipline

Psychologist

Social Worker

Counsellor / Therapist

Clergy / Pastoral Care

Marriage & Family Therapist

Physician / Nurse

Professor / Lecturer

Researcher

Funeral Service

Coach

Art or Expressive Arts Therapist

Others:

Registration

Join this live stream webinar with an accompanying Course Pack and Responsive Journal,

as well as the opportunity to interact through breakouts and the question and answer period.

*One registration is only intended for one participant and cannot be shared among multiple learners.

Please kindly indicate which session you would like to join:

NOTE: For registrants who wish to enroll in Certification Program,

the total price will be above price + $100 Enrollment Fee 

**Participants in this live stream webinar are eligible for certification credit for 1 Practicum Session.

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Terms and Conditions  

 

1. You will receive a confirmation of registration via email upon payment completion. 

2. Refund policy

Should you be unable to attend the “Collage: Practicum Studio” live stream webinar as registered, you may write in to the Portland Institute (PI) to request for withdrawal and refund according to the following guidelines:

   a) 1 week before webinar commences: refund minus 10% service fee

   b) Within 1 week before webinar commences: No refund permitted

 

3. PI reserves the right to make any necessary changes to the webinar program without prior notice to the registrants.

Agreement

By registering for the “Collage: Practicum Studio” live stream webinar, I acknowledge and agree with the above-mentioned terms and conditions. I consent to the use of my personal data and payment details for this registration.

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